<field:nianling itemname="受助年龄" autofield="1" notsend="0" type="int" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:nianling>
<field:quyu itemname="区域（省市）" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:quyu>
<field:shenqingshijian itemname="申请时间" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:shenqingshijian>
<field:zhuangtai itemname="状态" autofield="1" notsend="0" type="radio" isnull="true" islist="1" default="已申请,审核中,审核未通过,材料补充中,待筛查,审核通过,救助中,救助完成,申请关闭"  maxlength="250" page="">
</field:zhuangtai>
<field:zizhujine itemname="爱尔资助金额（万元）" autofield="1" notsend="0" type="float" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:zizhujine>
<field:zizhuleixing itemname="资助类型" autofield="1" notsend="0" type="radio" isnull="true" islist="1" default="A,B,C"  maxlength="250" page="">
</field:zizhuleixing>
<field:xingbie itemname="性别" autofield="1" notsend="0" type="radio" isnull="true" islist="1" default="男,女"  maxlength="250" page="">
</field:xingbie>
<field:chushengriqi itemname="出生日期" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:chushengriqi>
<field:minzu itemname="民族" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:minzu>
<field:huanerno itemname="患儿身份证号" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:huanerno>
<field:hukou itemname="户口类型" autofield="1" notsend="0" type="radio" isnull="true" islist="1" default="城镇居民,农村,其他"  maxlength="250" page="">
</field:hukou>
<field:hujizhuzhi itemname="户籍住址" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:hujizhuzhi>
<field:jiatingzhuzhi itemname="家庭住址" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jiatingzhuzhi>
<field:jianhurenname itemname="监护人姓名" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jianhurenname>
<field:guanxi itemname="关系" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:guanxi>
<field:jianhurenlianxi itemname="监护人联系方式1" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jianhurenlianxi>
<field:jianhurenlianxi2 itemname="监护人联系方式2" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jianhurenlianxi2>
<field:jianhurenshno itemname="监护人身份证号" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jianhurenshno>
<field:jinjirenname1 itemname="紧急联系人1" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jinjirenname1>
<field:jinjiren1guanxi itemname="紧急人1-关系" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jinjiren1guanxi>
<field:jinjiren1lianxi itemname="紧急人1-联系方式" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jinjiren1lianxi>
<field:jinjiren2 itemname="紧急联系人2" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jinjiren2>
<field:jinji2guanxi itemname="紧急人2-关系" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jinji2guanxi>
<field:jinji2lianxi itemname="紧急人2-联系方式" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jinji2lianxi>
<field:shebao itemname="是否参加社会医疗保障" autofield="1" notsend="0" type="radio" isnull="true" islist="1" default="城镇居民基本医疗,新农合,无医疗保障,其他"  maxlength="250" page="">
</field:shebao>
<field:jieshoujiuzhu itemname="是否接受过其他社会援助" autofield="1" notsend="0" type="radio" isnull="true" islist="1" default="是,否"  maxlength="250" page="">
</field:jieshoujiuzhu>
<field:shouzhuriqi itemname="受资助日期" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:shouzhuriqi>
<field:zizhujigou itemname="资助机构/个人名称" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:zizhujigou>
<field:zizhujineaier itemname="其他机构资助金额(万元)" autofield="1" notsend="0" type="float" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:zizhujineaier>
<field:jiazongshouru itemname="家庭年度总收入（万元）" autofield="1" notsend="0" type="radio" isnull="true" islist="1" default="1,2,5,10"  maxlength="250" page="">
</field:jiazongshouru>
<field:jiarenjunshouru itemname="家庭人均年收入（万元）" autofield="1" notsend="0" type="radio" isnull="true" islist="1" default="0,1,3,5"  maxlength="250" page="">
</field:jiarenjunshouru>
<field:jiarenkou itemname="家庭人口" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jiarenkou>
<field:jialaodongli itemname="家庭劳动力人口" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jialaodongli>
<field:duoxuan itemname="是否符合右表 所列情况 （可多选）" autofield="1" notsend="0" type="checkbox" isnull="true" islist="1" default="建档立卡户,低保户,残疾证,军烈属家庭,其他"  maxlength="250" page="">
</field:duoxuan>

<field:danganno itemname="贫困户档案编号" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:danganno>
<field:dibaono itemname="低保证编号" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:dibaono>
<field:junlieshuno itemname="军烈属证编号" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:junlieshuno>
<field:fulijigou itemname="福利机构名称及联系方式" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:fulijigou>
<field:shenqingshuoming itemname="家庭困难说明" autofield="1" notsend="0" type="htmltext" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:shenqingshuoming>

<field:juweihui itemname="家庭所在地/村（居）委会" autofield="1" notsend="0" type="htmltext" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:juweihui>
<field:xiangzhen itemname="家庭所在地乡镇/街道办事处" autofield="1" notsend="0" type="htmltext" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:xiangzhen>
<field:quezheng itemname="疾病名称/事故原因" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:quezheng>

<field:fabingshijian itemname="发病时间" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:fabingshijian>
<field:quezhengshijian itemname="确诊时间" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:quezhengshijian>
<field:quezhengyiyuan itemname="确诊医院" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:quezhengyiyuan>
<field:cengyiyuan1 itemname="曾治疗医院1" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:cengyiyuan1>
<field:zhiliao1 itemname="治疗日期1" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:zhiliao1>
<field:cengyiyuan2 itemname="曾治疗医院2" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:cengyiyuan2>
<field:zhiliao2 itemname="治疗日期2" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:zhiliao2>
<field:cengyiyuan3 itemname="曾治疗医院3" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:cengyiyuan3>
<field:cengriqi3 itemname="治疗日期3" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:cengriqi3>
<field:xunlianleibie itemname="康复训练类别" autofield="1" notsend="0" type="radio" isnull="true" islist="1" default="机构康复,家庭训练,未接受康复训练"  maxlength="250" page="">
</field:xunlianleibie>
<field:jigoushijian itemname="机构康复累计时间" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jigoushijian>
<field:kangfu1shijian itemname="康复起始时间1" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:kangfu1shijian>
<field:kangfujigou1 itemname="康复机构1" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:kangfujigou1>
<field:kangfushijian2 itemname="康复起始时间2" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:kangfushijian2>
<field:kangfujigou2 itemname="康复机构2" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:kangfujigou2>
<field:kangfushijian3 itemname="康复起始时间3" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:kangfushijian3>
<field:kangfujigou3 itemname="康复机构3" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:kangfujigou3>
<field:qitajibing itemname="患儿是否患有其他重大疾病" autofield="1" notsend="0" type="radio" isnull="true" islist="1" default="是,否"  maxlength="250" page="">
</field:qitajibing>
<field:jianshu itemname="其他疾病简述" autofield="1" notsend="0" type="htmltext" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jianshu>
<field:jianhurenqianzi itemname="监护人签字" autofield="1" notsend="0" type="text" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jianhurenqianzi>
<field:kfjs1 itemname="康复1结束时间" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:kfjs1>
<field:kfjs2 itemname="康复结束时间2" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:kfjs2>
<field:kfjs3 itemname="康复结束时间3" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:kfjs3>
<field:yyyj itemname="定点医疗机构审核意见" autofield="1" notsend="0" type="htmltext" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:yyyj>
<field:aieryijian itemname="爱尔意见" autofield="1" notsend="0" type="htmltext" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:aieryijian>
<field:beizhu itemname="标识后台提交过一次的数据" autofield="1" notsend="0" type="htmltext" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:beizhu>
<field:liyou itemname="康复医师意见" autofield="1" notsend="0" type="htmltext" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:liyou>
<field:num itemname="编号" autofield="1" notsend="0" type="int" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:num>
<field:hrimg itemname="患儿照片" autofield="1" notsend="0" type="imgfile" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:hrimg>
<field:jhrsqz1 itemname="法定监护人身份证(正面)" autofield="1" notsend="0" type="imgfile" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:jhrsqz1>
<field:jhrsfz2 itemname="法定监护人身份证(背面)" autofield="1" notsend="0" type="imgfile" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jhrsfz2>
<field:jhrhkzy itemname="法定监护人户口本(主页)" autofield="1" notsend="0" type="imgfile" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jhrhkzy>
<field:jhrhkb itemname="法定监护人户口本(本人页)" autofield="1" notsend="0" type="imgfile" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jhrhkb>
<field:hrsfz itemname="患儿身份证\户口本\出生证" autofield="1" notsend="0" type="imgfile" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:hrsfz>
<field:jtqkzm itemname="家庭情况证明" autofield="1" notsend="0" type="imgfile" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:jtqkzm>
<field:sqly itemname="申请理由（200字）" autofield="1" notsend="0" type="htmltext" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:sqly>
<field:tijiao itemname="提交状态" autofield="1" notsend="0" type="int" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:tijiao>
<field:test itemname="就诊医院" autofield="1" notsend="0" type="radio" isnull="true" islist="0" default="北京中医药大学东直门医院,北京中日友好医院,首都儿科研究所附属儿童医院,新疆医科大学附属第二人民医院,新疆生产建设兵团医院,喀什地区第二人民医院,西藏自治区第二人民医院,林芝市人民医院,广州市红十字会医院"  maxlength="250" page="">
</field:test>
<field:shztime itemname="审核中时间" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:shztime>
<field:shjgtime itemname="审核结果时间" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:shjgtime>
<field:zzztime itemname="资助中时间" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:zzztime>
<field:yzztime itemname="已资助时间" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:yzztime>
<field:clbctime itemname="材料补充中时间" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:clbctime>
<field:dsctime itemname="待筛查" autofield="1" notsend="0" type="datetime" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:dsctime>
<field:dibaoimg itemname="低保户证明" autofield="1" notsend="0" type="imgfile" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:dibaoimg>
<field:junlieshuimg itemname="军烈属证明" autofield="1" notsend="0" type="imgfile" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:junlieshuimg>
<field:qitaimg itemname="其他经济状况证明" autofield="1" notsend="0" type="imgfile" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:qitaimg>
<field:shoushufei itemname="手术费用" autofield="1" notsend="0" type="float" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:shoushufei>
<field:kangfufei itemname="康复费用" autofield="1" notsend="0" type="float" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:kangfufei>
<field:ercishoushufei itemname="二次手术费" autofield="1" notsend="0" type="float" isnull="true" islist="1" default=""  maxlength="250" page="">
</field:ercishoushufei>
<field:sn_type_ac itemname="AC表" autofield="1" notsend="0" type="text" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:sn_type_ac>
<field:sn_canji_img itemname="患儿残疾人证书复印件" autofield="1" notsend="0" type="imgfile" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:sn_canji_img>
<field:sn_zhenduan_img itemname="诊断证明" autofield="1" notsend="0" type="imgfile" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:sn_zhenduan_img>
<field:sn_shoushu_time itemname="一期手术时间" autofield="1" notsend="0" type="datetime" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:sn_shoushu_time>
<field:sn_shoushu_yiyuan itemname="手术医院" autofield="1" notsend="0" type="text" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:sn_shoushu_yiyuan>
<field:sn_shoushu_buwei itemname="手术部位" autofield="1" notsend="0" type="text" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:sn_shoushu_buwei>
<field:sn_kangfu_long itemname="术后康复时长" autofield="1" notsend="0" type="text" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:sn_kangfu_long>








<field:body itemname="文章内容" autofield="1" notsend="0" type="text" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:body>

<field:lianxidianhua itemname="联系电话" autofield="1" notsend="0" type="text" isnull="true" islist="0" default=""  maxlength="250" page="">
</field:lianxidianhua>
